Financial Case Coordinator - Transplant

We are looking for a Financial Case Coordinator - Tranplant to join our team! As a member of the transplant team, the Transplant Financial Case Coordinator manages and/or coordinates all financial issues with patients, insurers, referring and attending physicians, nurse coordinators, social workers and other stakeholders.

This case coordinator schedule includes;

• 80 hours every two weeks
• Full time; Day shift
• No weekends

Responsibilities:

• Perform insurance verification and analysis as described below:
• Determine eligibility status,
• Obtain benefit information,
• Verify group/contract numbers and subscriber information, and
• Verify applicable contract and/or network.
• Includes facility, physician, home health care, home infusion, pharmacy, and travel/meals/lodging benefits as appropriate
• Obtain certification and/or authorization of admission or service and furnish necessary information to utilization review for concurrent review.
• Identify potential coverage issues and works with:
• Specific Fairview program (UMP, HHC, IV, Rx),
• Patient,
• Admitting physician,
• Referring physician,
• Insurance company, and
• Employer.
• Research to find other programs for payment and/or negotiate with third party payers to provide coverage by submitting medical data, citing precedents set by other payers and providing cost benefit information.
• Maintain current knowledge of payer requirements and general admitting practices including use of on-line verification applications and initial and ongoing training.
• Provide financial counseling and support for patients as needed during the course of their treatment. Assist in resolving problems with payers and provide information and expertise to other departments.
• Demonstrate ability to provide care or service adjusting approaches to reflect developmental level and cultural differences of population served.
• Demonstrate ability to counsel patients with billing inquiries
• Provide itemizations to patients and/or social workers as requested
• Direct patients to the correct billing entity, as appropriate
• Coordinate with other billing entities to provide financial answers to patient inquiries
• Secure services associated with potential transplant patients
• Clinical Trail Drugs (MIBG, IL-15, CD-34, CD-19)
• Pre/Post-transplant stem cell infusions (Rescue/NK/DLI)
• Pre-BMT preparatory drugs (growth factor, Mozobil, etc.)
• Genetic Testing/Counseling as appropriate
• Pocket Controllers and supplies for VAD patients
• Enteral Nutrition for TP-IAT patients
• Secure services for non-transplant patients
• Natural Killer Cell Infusions (NK)
• Destination Therapy Ventricular Assist Devices (DT-VADs)
• Pocket controllers and supplies for DT-VAD patients
• Genetic Testing/Counseling
• Secure services for non-transplant patients
• Natural Killer Cell Infusions (NK)
• Destination Therapy Ventricular Assist Devices (DT-VADs)
• Pocket controllers and supplies for DT-VAD patients
• Genetic Testing/Counseling
• Financial Exceptions
• Determine need for a financial exception
• Coordinate with physician and/or nurse coordinator to determine the sponsorship and outline of financial exception
• Work with UMP to draft FE and obtain signatures
• Coordinate with billing office to apply FE standards to billing
• Work with potential international and self-pay patients
• Create customized estimates based on medical services provided
• Work with patients/families/embassies to collect deposits
• Work with the billers to understand the distribution of funds
• Work with patients/families/embassies to collect additional funds as needed
• Provide documentation needed to patient/family/embassy (itemizations, bills, etc.)
• Request deposit refund be submitted to patient/family/embassy if funds are remaining after patient is discharged from care
• Coordinate with all providers of service
• Confirm enrollment with atypical insurance providers
• Negotiate rates for reimbursement for financial exceptions
• Confirm acceptance of insurance rates
• Including but not limited to UMP, HHC, IV, Rx
• Kidney Paired Donation (KPD)
• Secure coverage for recipient at UMMC
• Coordinate with other facility or facilities involved in the KPD to ensure that their recipient has insurance for our donor
• Coordinate with other facility or facilities involved in the KPD to ensure that the other facility accepts the insurance of our recipient for their donor
• Counsel patient(s) involved as necessary, including Medicare education
• Retroactively secure insurance coverage for patients transplant prior to securing financial resources
• Counsel patients on insurance options
• Work with other providers of service (UMP, HHC, IV, Rx) to navigate coverage gaps
• Assist patients with navigating insurance options
• MNSure website
• Insurance brokers
• Medicare counseling
• Research supporting clinical and non-clinical documentation in an attempt to gather as much information as possible to secure coverage for transplantation (including but not limited to research journals, articles, etc.)
• Demonstrates Commitment to Customers
• Is aware of different customer needs/desires.
• Takes action to meet customer needs/desires with respect to customer diversity.
• Helps improve processes to meet customer needs.
• Suggests and acts on ideas to improve overall customer service.
• Respects confidentiality and shares information with only those that need to know
• Demonstrates Commitment to Fellow Employees
• Seeks to understand and value differences between employees.
• Treats other employees with dignity and respect.
• Demonstrates open, honest communication and behavior.
• Resolves conflict in a positive manner.
• Contributes to the productivity of the workgroup.
• Demonstrates Commitment to Fairview
• Lives the values of dignity, integrity, service and compassion.
• Supports the mission/vision.
• Speaks positively about Fairview.
• Chooses to make Fairview a better place.
• Organizational Expectations
• Completes all initial and annual required learning relevant to the role.
• Complies with all relevant laws, regulations, and policies.
• Contributes to a safe work environment.
• Organizational Expectations
• Completes all initial and annual required learning relevant to the role.
• Complies with all relevant laws, regulations, and policies.
• Contributes to a safe work environment.

Required Qualifications:

• B.S./B.A. in business, communications or liberal arts field or equivalent combination of education and experience
• 2-3 years of experience (or equivalent combination of education and experience) in healthcare or insurance organizations related to admitting, billing, claims processing, financial counseling, collections, contracting.
• Strong knowledge of computer systems.

Preferred Qualifications:

• Knowledge of EPIC System and Transplant Services experience preferred
• Knowledge of PASS System
• Knowledge of transplant services

Fairview offers a generous benefit package including but not limited to medical, dental, vision plans, life insurance, short-term and long-term disability insurance, PTO and Sick and Safe Time, tuition reimbursement, retirement, early access to earned wages, and more! Please follow this link for additional information: https://www.fairview.org/careers/benefits/noncontract

An individual's pay rate within the posted range may be determined by various factors, including skills, knowledge, relevant education, experience, and market conditions. Additionally, our organization prioritizes pay equity and considers internal team equity when making any offer. Hiring at the maximum of the range is not typical. If your role is eligible for a sign-on bonus, the bonus program that is approved and in place at the time of offer, is what will be honored.

Salary : $26 - $37